- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.31 / $7,117.60 / $14,644.00
| Facility | | $465.31 | $7,117.60 | $14,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,252.64 / $7,306.28 / $11,947.84
| Facility | | $3,252.64 | $7,306.28 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.12 / $2,345.00 / $2,581.96
| Facility | | $691.12 | $2,345.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.31 / $2,038.25 / $3,159.28
| Facility | | $465.31 | $2,038.25 | $3,159.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $12,456.00 / $19,665.00
| Facility | | $2,327.00 | $12,456.00 | $19,665.00 |